Lippincott Nursing Pocket Card - August 2022

Integumentary Assessment



The integumentary system includes the skin, hair and nails. Make sure there is adequate lighting and have the patient change into a gown. Have a small tape measure or magnifying glass available to measure or examine lesions more closely.


Optimal Patient Positioning

  • If possible, examine the patient first seated, then standing; or examine the patient while supine, then prone.
  • Ask permission to expose any areas covered by the gown before adjusting the gown to see each area.
  • Consider patient comfort, modesty, and having a chaperone present during these examinations. 

Exam Methods

  • Inspection
    • To ensure that all areas are examined, consider this order for inspection.
      • While patient is seated
        • Assess the hair, noting the distribution, texture, and quantity.
        • Use your fingers or cotton-tipped applicator to separate the hair and examine the scalp from one side to the other.
        • Inspect the head and neck, including forehead, eyebrows, eyelids, eyelashes, conjunctivae, sclerae, nose, ears, cheeks, lips, oral cavity, chin, and beard.
        • Have the patient lean forward to assess the upper back.
        • Inspect the shoulders, arms, and hands, including the fingernails.
        • Inspect the anterior chest and abdomen, followed by the anterior thighs and legs.
        • Assess the feet and toes including the soles, interdigital areas, and toenails.
      • While patient is standing
        • Inspect the lower back, followed by the posterior thighs and legs.
        • Lastly, inspect the breasts, axillae, and genitalia including hair in the axillae and pubic area.
  • Palpation
    • While inspecting the integumentary system, palpate the fingernails and toenails, and also any lesions to determine texture, firmness, and scaliness.


  • Pallor indicates anemia. Cyanosis can indicate decreased oxygen in the blood or decreased blood flow in response to a cold environment. Jaundice, or yellowing of the skin, results from increased bilirubin.
  • Longitudinal bands of pigment on the nails are normal in people with darker skin.
  • If performing a routine physical assessment, integrate aspects of the integumentary assessment into that examination. For example, when auscultating the lungs posteriorly, fully assess the back at that time.
  • Teach the patient about regular skin self-examination and the ABCDE-EFG method for assessing moles.
  • Document your findings using the correct terminology to describe skin lesions.

Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bate’s Guide to Physical Examination and History Taking (13th ed.). Wolters Kluwer Health: Philadelphia.